Please print this page and mail or fax it to
Nonprofit Works Inc.
117 Van Dam Street
Saratoga Springs, NY 12866
(518) 581-8841, Fax: (518) 581-8861
Course info
Course Title: _____________________________________________________________
How did you hear about the course? ________________________________________
Contact info
Organization: ____________________________________________________________
Person(s) to attend: _____________________________________________________
(names)
_____________________________________________________
Address: _________________________________________________________________
_________________________________________________________________
Phone: _____________________________________________________
Fax: _____________________________________________________
E-mail: _____________________________________________________
Payment info
Course cost $ _________ X ______ person(s) = TOTAL $ _____________
Payment method: ____Check ____VISA ____MasterCard ____AmEx
Please complete the following if paying by Visa, MasterCard or American Express.
Cardholder information
Name: __________________________________________________
Address/Zip: _______________________________________________________________
Account #: ________-________-________-________ Expiration: ______ / ______
Signature: ______________________________________ Date: __________________